Lotsavan Chandavong, RN

Primary specialty

Emergency Registered NurseTaxonomy code 163WE0003X

License

9322682 Issued in FL

Practice address

516 E Nizhoni Blvd
Gallup, NM 87301-5748

Phone

(505) 722-1000

NPI assigned

Feb 26, 2020

Last updated

Feb 26, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1649804915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 S NARANJA AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349832221",
            "telephone_number": "754-234-3044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 E NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015748",
            "telephone_number": "505-722-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDAVONG",
        "first_name": "LOTSAVAN",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-26",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "FL",
            "license": "9322682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chakravarthy Chalamala, RPH
• Cristen Chamberlain, RN
• Johanna Chambers, RN
• Clay Joseph Champion, RN
• Irene Zuhue Chan, PHARM.D.
• April Chandler, RN
• Demetrius Chapman, MPH, MSNR, APRN, BC
• John Chapman
• Gabrielle Ariana Charleston, RN
• Ophelia Charleston

• Emergency Registered Nurse in Gallup, NM
• Providers in Gallup, NM by specialty
• Emergency Registered Nurse in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.